Lillian Jeffries – Sun City, CA

As told by Lillian Jeffries:

My medical problems began in 1997, when, after suffering from severe sciatica pain (a nerve condition), I underwent a hip replacement surgery on the advice of my doctors. Since that surgery, my condition has severely deteriorated. I have spent 95 percent of my time with my leg and foot elevated in order to be even minimally comfortable. I sleep less than four hours per night, and I am in unrelenting pain, which has been treated with continuing and frequent changes in, and additions to, medications. I am dependent on others to perform all but the most basic tasks for me, yet I spend hours on costly telephone calls trying to get the attention I need. To date, my condition remains undiagnosed, although I have been told repeatedly that I have undergone "successful" surgery.

Throughout my medical treatment, I have experienced persistent problems with my HMO. My grievances include stalling of treatment and tests, limited access to specialists, and extremely poor customer service overall.

The negligence began when my doctor recommended that I undergo three epidural injections, to be administered in 2-week intervals. My HMO requires treatment requests to be submitted and authorized before a doctor can treat a patient, creating delays in treatment. Instead of the HMO approving all three at once, each individual session required new forms to be submitted and further delays between injections. This delay resulted in my epidural injections to be given in intervals longer than the two weeks recommended by my doctor.

My chronic pain ensued, so I was tested for a suspected blood clot. Not only was I treated rudely by the desk clerk when trying to get an appointment, but I was virtually forgotten about while awaiting her test results. Had I not persistently phoned the lab, I most likely would not have heard from them.

On March 31, 1996, my doctor requested an authorization for me to be seen by a neurologist. Pending the HMO’s authorization, I was forced to wait a month for an appointment. When I finally got in to see the neurologist, I was flatly informed I had been given the wrong forms and told to reschedule. This stress caused a rapid and recorded rise in my blood pressure.

Eventually, I was given an exam, and the doctor concluded that I had a pinched nerve somewhere in my body and that a more comprehensive examination would be required. The doctor assured me that he would immediately process the request.

Throughout my involvement with my HMO, I have experienced frustration every step of the way. Departments are seriously understaffed, causing delays in treatment, and doctors are so overburdened that patients must wait three weeks or more for appointments, and are required to pick up and deliver x-rays and doctor authorizations, even when they are ill and have limited mobility. Furthermore, patients are asked to verbally convey findings of one doctor to another, rather than there being direct doctor to doctor communications.

Therapists and anesthesiologists are not provided with treatment plans or results of diagnoses, nor are caregivers providing the patient with copies of all authorization forms, as prescribed by law.

I am concerned by the lack of knowledge and apathy towards pain management, resulting in high narcotics dosages. I also question the excessive delays, due to the need for all recommendations of treatment from specialists be approved by primary care doctors, and then by the provider staff. Why make referrals to specialists whose medical expertise can be questioned and countermanded by non-specialists or even nonprofessionals?

The HMO is protected by a federal law called ERISA (Employee Retirement Income Security Act). The ERISA loophole shields health maintenance organizations from damages when they delay and deny medically appropriate treatment for patients who receive their health care through their employers, like me.

I am dismayed and disgusted by this pervasively callous disregard for timely and effective patient care. Something is wrong when a painful and debilitating condition is treated like a common cold.